Creating Consistency through a Master Training Booklet & Immunization Manual Redwood Community Health Coalition Promising Practice

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1 1/22/19 Creating Consistency through a Master Training Booklet & Immunization Manual Redwood Community Health Coalition Promising Practice PROMISING PRACTICE OVERVIEW In 2014 Sonoma Valley Community Health Center (SVCHC) created a training booklet (informally called The Bible ) to both train new staff and act as a reference guide for existing staff. While the booklet is described as a broad overview of policies, procedures, and workflows, it s now almost 800 pages. The booklet provides staff a solid foundation on required measures and at the same time helps create consistency of work across the organization. Updated annually, it contains a large number of the health center s key workflows, including childhood immunizations (IZ). Starting in 2016, the health center began experiencing staff turnover, specifically medical assistants (MAs). Not surprisingly this has made it difficult to keep measure rates high and staff on the same page. The training booklet has been vital in this effort. ACTIONS TAKEN Created resources for staff: Training Booklet developed in 2014 and updated yearly. The QI department conducts two 4 hour trainings when a new version of the booklet is released. Immunization Template Training Manual used for IZ specific workflows. Training Plan for MAs includes review of all workflows and measures as part of onboarding process. Plan includes review of training booklet and manual resources. Encourage staff to look at measures in different ways to understand what the measures are, what they mean, and what closing the loop for each entails. WORKFLOW UDS Childhood Immunizations AIM To increase childhood immunization rates through consistency in health center procedures and workflows. MEASURES Numerator: Documentation of a full immunization on or before the second birthday; A full immunization is all of the following: 4 DTP/DTaP, 3 IPV, 1 MMR, 3 Hib, 3 Hep B, 1 VZV, 4 Pneumococcal conjugate, 1 Hep A, 2 or 3 RV, and 2 influenza. Denominator: Patients who had their second birthday within reporting period; Had at least one medical visit during reporting period; Had at least one medical visit any time prior to the second birthday; Exclusion: contraindication for the vaccine or a history of illness. SVCHC Childhood IZ Rates % 67.3% Expected around 60% Training Booklet The Bible Immunization Template Training Manual Childhood Immunization section includes: workflow for back office staff, CQI coordinator and IZ coordinator, and provider information on what to cover during well child visits and patient education to provide information on types of flu vaccines for children Manual informs staff how to do the following: vaccine set up using NextGen s Ngkbm IZ practice template that SVCHC has customized updating the vaccine inventory ordering IZ understanding vaccine alert displays processing IZ orders obtaining CAIR consent CHALLENGES Vaccine Set-up using Ngkbm Immunizations Practice Template SVCHC has some parents who refuse to vaccinate, making it harder to improve overall rates. Some patients see providers outside the health center, which can make it difficult to get the release of their records. The lack of interface between The California Immunization Registry (CAIR) and NextGen continues to be challenging. Data quality is impacted when staff select the incorrect vaccine in the system. NextGen Immunization Pediatric Template LESSONS LEARNED Staff must know who s responsible for getting a patient s record up to date. For example when a provider reviews a chart (regardless of if they re the PCP), they become responsible for making sure all required IZ have been done. Similarly MAs are responsible entering IZ into patient records and CAIR. When providers take their IZ rates seriously, they ask for details on their patient specific rates. They communicate the importance of missed opportunities with their team.

2 Document Title: Childhood Immunizations, 0-2 years of age Page 1 of 9 Document Type: Procedure Document ID Number: Department: Clinical Operations Author: Marianne Clinton, MD, CMO, revised by Julie M Vlasis, CQI Consultant Implementer/Owner: Carol Ahern, MD CMO, Teresa Rodriguez, Clinic Manager Approval Date: 4/1/2014 Training Date: 4/16/2014, 02/16/2016, 1/21/2017, 1/17/2018. Implementation Date: 4/16/2014 Revision Date: 01/01/2016, 09/13/2017,11/5/2018 Effective Date: 4/16/2014 Next Review Date: 04/01/2020 STATEMENT OF PURPOSE: To ensure that children are fully immunized according to current guidelines on or before their second birthday. DEFINITIONS: Evidence Based Guidelines: Clinical Practice guidelines based on scientific evidence; or in the absence of scientific evidence, professional standards, or in the absence of professional standards, an expert opinion. Practice Guidelines: Systematically developed descriptive tools or standardized procedures for care to support clinician and patient decisions about appropriate health care for specific clinical circumstances. Practice guidelines are typically developed though a formal process and are based on authoritative sources that include clinical literature and expert consensus. Important Condition: A condition including an unhealthy behavior, substance abuse or mental health issue, with evidence based clinical guidelines that affect a large number of people or consumes a disproportionate amount of health resources. NextGen Enterprise Practice Management (EPM): NextGen EPM is the application used primarily for billing and is also used to manage appointments. Other functions of EPM include, but are not limited to, storing patient demographics, posting transactions, and processing charges. NextGen Electronic Health Records (EHR): NextGen EHR is the application used to store and maintain a patient s electronic chart. Clinical information such as lab results, health history, and diagnosis history are located in EHR.

3 Document Title: Childhood Immunizations, 0-2 years of age Page 2 of 9 History of Present Illness (HPI): The HPI is a chronological description of the development of the patient s present illness including the following elements: Location, Quality, Severity, Duration, Timing, Context, Modifying factors and Associated signs and symptoms Brief and Extended HPI s are distinguished by the amount of detail needed to characterize the clinical problem or problems accurately: Brief consists of 1 to 3 elements. Extended - consists of 4 or more element BACKGROUND: It is the policy of Sonoma Valley Community Health Center that we adopt a goal of providing all our patient's ages 0-2 years with current immunizations. As reported by the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC), keeping immunizations on track by not delaying well child appointments based on the periodicity schedule between children approaching 2 years of age. If the Child is last in receiving their well child exam early in life, it can have a compounding effect, delaying future well child visits and immunizations. ASSUMPTIONS: According to the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) vaccines due before the child s second birthday are actually scheduled to be completed by the 18 th month of life. The provider will ensure that the next visits are documented in the CHDP Review Document within the NextGen System. The Front Desk at Check-out will ensure that all children 0-21 are placed on the appropriate recall if the provider of record has neglected to indicate the correct interval. The Back Office Staff will use the Pediatric Huddle Sheet for all Pediatric visits not just well child visit to ensure that no immunizations or visits are missed. Immunization records will be checked at every pediatric appointment against the CAIR Registry to ensure SVCHC has the most updated patient record. PCMH (Patient Care Medical Home) Related: Yes (X); No () NextGen EPM/EHR Procedure is needed for this Procedure: Yes (X); No () PROCEDURES: The Medical Back Office Staff are responsible for: 1. Print CAIR report to identify missing vaccinations prior to the daily huddle. 2. The Medical Back Office Staff are required to update the patient immunization record in NextGen prior to the patient visit.

4 Document Title: Childhood Immunizations, 0-2 years of age Page 3 of 9 3. The Medical Back Office staff will obtain and review with the provider the Pediatric Huddle Sheet, at every pediatric visit including Well Child visits. 4. Discuss with provider missing vaccinations and have provider order them in patient electronic health record in the immunization module. 5. Complete CAIR Consent and CAIR Registry Identification Number. 6. Obtains consent and reviews child vaccine questionnaire with parent 7. Educate parents on the vaccine(s), including any known reactions 8. Prints and hands parent VIS for each vaccine, making sure the documents show in the patient electronic medical record. 9. Uses universal precautions and proper infection control techniques to prepare vaccines under the supervision of a licensed staff person 10. Utilizing; the 5 medication verification points (correct patient, correct vaccine, correct dose, correct route, correct timing of vaccine) administer vaccine(s). 11. Document in NextGen Immunization module all of the required fields that vaccine order is completed. (Documentation in NextGen and CAIR should be consistent.) 12. Document in CAIR vaccines given. 13. Parent given copy of current immunizations. The CQI Coordinator and Immunization Coordinator will review monthly. 1. Print and review reports identifying patients age 0-2 years needing vaccinations. 2. Contact parents/guardians to schedule an appointment. 3. Follow through with requests from the providers. The Provider will be responsible to: 1. Perform an appropriate history and physical examination. 2. Review immunization template in NextGen to check the patient's record for due and past due immunizations. 3. Check patient s allergies and diagnosis history for any contraindications for vaccinations. 4. Review the consent for immunizations reviewing risks and benefits with parents that the Medical Back Office Staff have completed with the parent. 5. Children who have contraindications for a required immunization will have the immunization ordered. The Medical Back Office Staff will document the contraindication on the vaccine as required. 6. Parents who decline immunization(s) for their child; will be required to complete declination paperwork. The provider will order the vaccine, and the Medical Back Office Staff will document on the vaccine in the patient electronic medical record has been refused by the parent. Well Child Visits a. All Providers complete the CHDP Review in the Next Gen System (regardless of insurance type) for all well child visits as a guideline to ensure proper documentation, noting vaccinations given along with physical assessment and all required diagnosis codes.

5 Document Title: Childhood Immunizations, 0-2 years of age Page 4 of 9 b. The provider has provided patient with next scheduled CHDP visit in the electronic medical record with use of the CHDP HPI in NextGen. This allows the patient to be placed on the correct recall. c. The Medical Back Office Staff prints the CHDP document from the patient's chart and provides to the parent of the child. d. The Front Office Staff ensure that all Children have a Well Child recall upon leaving the health center at any visit. Patient Education: Encourage families to keep immunizations up to date for their children. Review the importance of childhood immunizations. Refer families to the vaccine information sheet (VIS) for specific information and precautions about each vaccine Notifying SVCHC should child experience a non-life threatening reaction to a vaccine Childhood Immunizations Age Birth through 2 Years of age as required by CMS CMS Measure CMS117v7 published 6/1/2018. (See tool below.)

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8 Document Title: Childhood Immunizations, 0-2 years of age Page 7 of 9 The best way to prevent flu is with a flu vaccine. CDC recommends that everyone 6 months of age and older get a seasonal flu vaccine each year by the end of October. However, as long as flu viruses are circulating, vaccination should continue throughout the flu season, even in January or later. Keep in mind that vaccination is especially important for certain people who are at high risk or who are in close contact with high risk persons. This includes children at high risk for developing complications from flu illness and adults who are close contacts of those children. Flu vaccines are updated each season if necessary to protect against the influenza viruses that research indicates will be most common during the upcoming season. (See Vaccine Virus Selection for this season s exact vaccine composition.) The vaccine has been updated from last season s vaccine to better match circulating viruses. Immunity from vaccination sets in after about two weeks.

9 Document Title: Childhood Immunizations, 0-2 years of age Page 8 of 9 Types of flu vaccines for children Children 6 months and older should get annual influenza (flu) vaccine. For the flu season, CDC recommends annual influenza vaccination for everyone 6 months and older with any licensed, age-appropriate flu vaccine (IIV for children aged 6 months and older or LAIV4 for children 2 years of age and older) with no preference expressed for any one vaccine over another. Flu shots (IIV), vaccines are given as an injection and made with inactivated (killed) flu virus are approved for use in people 6 months and older. The nasal spray vaccine (LAIV4) is approved for use in people 2 through 49 years of age. However, there is a precaution against the use of the nasal spray flu vaccine (LAIV) in people with certain underlying medical conditions. More information about the nasal spray flu vaccine can be found here. Your child s health care provider will know which vaccines are right for your child. For more information on the different types of flu vaccines available visit CDC s Different Types of Flu Vaccines page. Special vaccination instructions for children aged 6 months through 8 years of age Some children 6 months through 8 years of age require two doses of influenza vaccine. Children 6 months through 8 years getting vaccinated for the first time, and those who have only previously gotten one dose of vaccine should get two doses of vaccine this season. All children who have previously gotten two doses of vaccine (at any time) only need one dose of vaccine this season. The first dose should be given as soon as the vaccine becomes available. The second dose should be given at least 28 days after the first dose. The first dose primes the immune system; the second dose provides immune protection. Children who only get one dose but need two doses can have reduced or no protection from a single dose of flu vaccine. If your child needs the two doses, begin the process early. This will ensure that your child is protected before influenza starts circulating in your community. Be sure to get your child a second dose if he or she needs one. It usually takes about two weeks after the second dose for protection to begin. Children should be vaccinated every flu season Children should be vaccinated every flu season for the best protection against flu. For children who will need two doses of flu vaccine, the first dose should be given as early in the season as possible. For other children, it is good practice to get them vaccinated by the end of October. However, getting vaccinated later can still be protective, as long as flu viruses are circulating. While seasonal influenza outbreaks can happen as early as October, in most seasons influenza activity peaks between December and February. Since it takes about two weeks after vaccination for antibodies to develop in the body that protects against influenza virus infection, it is best that

10 Document Title: Childhood Immunizations, 0-2 years of age Page 9 of 9 people get vaccinated, so they are protected before influenza begins spreading in their community. POLICY THIS PROCEDURE SUPPORTS: 1. SVCHC Evidence Based Guidelines References: 1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2. CDC Immunization Guidelines: 3. CDC Influenza Guidelines for Infants and Children:

11 Immunization Template Training Manual Version 2.0 (revised November 21, 2017) Sonoma Valley Community Health Center 1

12 Contents Page(s) Vaccine Set-up Using Ngkbm Immunizations Updating Items in the Vaccine Inventory Ordering Immunizations Vaccine Alert Displays Processing Immunization Orders (Vaccine Orders Module)

13 Vaccine Set-up using Ngkbm Immunizations As with previous NextGen KBM versions, vaccine set-up is done through Ngkbm Immunizations Practice template. This template allows practices to input specify items within their vaccine inventory to include: Lot Numbers, number of units on hand, administration route (IM, SQ, oral, etc.), dose, and expiration date. This information is then utilized within the Immunizations template/module to auto-populate fields when a lot number is selected, which significantly streamlines workflow time. Ngkbm Immunizations template can be accessed through the file menu in NextGen EMR by utilizing the following workflow: Select File from the menu bar Select System/Practice Template Select the Practice Tab Select Ngkbm Immunizations from the menu items Note: Certain rights need to be granted to the NextGen EMR in order to access or modify items within this template. To add a new vaccine using Ngkbm Immunizations, the following workflow MUST be followed: Order Details: 1. Select Vaccine Name by selecting the CVX vaccine name: field within the Ngkbm Immunizations template. This will display a picklist, from which you will need to select the vaccine that you are adding to the inventory. Keep in mind that there can be multiple items within this picklist that are the same vaccine, but differ in dose and/or components, CVX code, and CPT (billing) code. Select this field 3

14 Note: When a pick-list item is selected, the fields for CVX, CPT, CPT description, and Status auto-populate with information that has previously been set-up within the database. 2. The next step in adding an item to the vaccine inventory is selecting a vaccine group. This is utilized as a unique identifier within the Immunizations Pediatric and Immunizations Adult templates, and therefore MUST be selected in order for the templates to work properly. To add a vaccine group, select the Group field within the Ngbm Immunizations template and select an item from the pick-list display that corresponds with the vaccine being added. Vaccine Information: The Vaccine Information section of the Ngkbm Immunizations template is where you populate information that will auto-populate fields within the Immunizations template and vaccine module when an order is processed (lot number, route, dose, expiration date, etc.). The general rule of thumb here is that the more information that is populated here, then less will need to be documented when a vaccine order is processed after administration. 1. Add a vaccine Name. This is entry specifies how the vaccine will display within the Immunizations Pediatric and Immunizations Adult template Type in the vaccine name as you would want it to display. 4

15 2. Add the strength of the vaccine. Keep in mind that the strength of each vaccine can vary from vaccine to vaccine and from manufacturer to manufacturer. The strength of a vaccine can be found on the vaccine packaging, or the vaccine itself. Type in a vaccine strength 3. Add a quantity for the vaccine by selecting the Quantity field and selecting the value from the number pad display. This is the dose of the vaccine that is to be administered (0.5 ml, 2ml, etc.). 4. Add a vaccine administration route by selecting the Route field and then selecting a pick-list item that corresponds to the vaccine delivery method for the vaccine being added. For example: Intramuscular for Hepatitis B, Subcutaneous for MMR, and Oral for Rotavirus. 5

16 5. Add an expiration date, lot number, and NDC ID number for the vaccine being added to the inventory. This information is found on the vaccine packaging and/or the vaccine itself, and can be unique to each new vaccine being added. 6. If the new vaccine being added is part of the Vaccines for Children or state funded program (VFC), then select the VFC check-box indicating such. 7. Type in a vaccine Brand name that corresponds to the vaccine being added to the inventory by selecting the Brand Name field. The vaccine brand name is unique to each vaccine, and could and can therefore vary from one vaccine to another. For example: Rotavirus can have a brand-name of Rota-Teq or Rotarix. 8. Add a vaccine manufacturer by selecting the Manufacturer field within the Ngkbm Immunizations template and selecting an item from the predefined pick-list display. 6

17 9. Select an ICD Code for the vaccine being added by selecting the Description field within the Ngkbm Immunizations template, and then searching for the code from the diagnosis search. 10. Add a location for the vaccine that is being added for the inventory by selecting the Location field and the selecting an item from the Location Master File. Due to the fact that Sonoma Valley Community Health Center has only 1 location at this time, SVCHC MUST be selected for each vaccine being added. MUST be selected for all vaccines 7

18 11. Select the Button to add the vaccine to the inventory. Updating Items in the Vaccine Inventory To update items that currently exist within the vaccine inventory, select the vaccine from the Lot Number Maintenance grid display. Vaccine information that currently exists will then display in the fields at the top of the Ngkbm Immunizations template, allowing modifications or changes to these fields. Once the modifications have been completed, you will then need to select the Button to effectively save the changes made. 1. Select vaccine from the grid display 2. Make changes in the fields at the top of the template. 8

19 3. Select the Button to save changes made. Ordering Immunizations: Vaccines are ordered within the NextGen EMR from the Immunizations Pediatric and or the Immunizations Adult template(s). These templates can be accessed from the sub-navigation bar within the *Intake and/or *SOAP template for most specialties and visit types. Example: Accessing the Immunizations - Pediatric or the Immunizations Adult template using Family Practice as the Specialty, and Office Visit as the Visit Type: Sub-navigation text link to access template Once the sub navigation item is selected, the corresponding immunization template will display. As with most KBM 8.3 templates, content within the Immunizations Pediatric and Immunization Adult templates are within collapsible panels. The first panel on the template(s) contain the vaccine orders (vaccine order options) The screenshot example below of the collapsible panel that contains the vaccine order options on the Immunization Pediatric template 9

20 Review Allergy Pop-up display When an initial vaccine is selected (check-box-click) on either the Immunizations Pediatric or the Immunizations Adult template, a Review allergy check pop-up will display that asks if the patient is allergic to Neomycin, Egg, Latex, or Gelatin. These substances may present in certain vaccines, and therefore all questions must be answered. Again, this only displays when the initial vaccine is selected If modifications are warranted to the Review Allergy pop-up display after it has been closed, then it can be accessed simply by selecting the at the right hand corner of the template. If an allergy has already been flagged (selected as Yes on the Review Allergies), then the Allergy Module can be accessed by selecting the next to the allergy flagged. Once the Allergy Review has been completed, a will display next to Relevant Allergies at the top of the template, indicating that the review of pertinent allergies has been completed 10

21 Vaccines with pick-list items: When a vaccine option is selected (check-box click), and more than one type of the vaccine currently exists in the inventory, then a pick-list will display. An example of this would be if both Rota Teq and Rotarix existed in the inventory, then a pick-list would display allowing the provider to select between the two vaccines. Another example would be Influenza where, in most cases, more than one type of this vaccine would be on hand. Screenshot example below is of the HPV vaccine where more than 1 type of the vaccine exists in the inventory. Selecting a Vaccine Sequence Once the allergy review and if applicable, the pick-list item has been selected, then the sequence pick-list pop-up will display for vaccines where more than one is clinically indicated. When this pop-up displays, simply select which sequence the vaccine is. For example, if ordering Hepatitis B for a patient, and the patient has previously received 2 doses of this vaccine, then the appropriate vaccine sequence to select would be 3 11

22 If an amendment needs to be made to the vaccine sequence after it has already been selected, then the text display of the sequence can be selected to re-display the immunization sequence pop-up display. Ordering Selected Vaccines: Once all vaccines that are to be ordered have been selected, then the ordered can be placed by selecting the button located at the bottom of the Vaccine Orders Panel 12

23 Immunization Alert Displays Throughout the immunization selection and/or ordering process, many different alerts may display. The purpose of these alerts is to prompt the user to take notice to certain patient conditions, or to consider taking a different course of action. Duplicate Vaccine Components Alert If vaccines with duplicate components are contained within a selected vaccine (check-box-click) on either the Immunizations Pediatric or the Immunizations Adult template, then an alert will display indicating such. The purpose of this alert is to prevent the ordering of vaccines with duplicate components. For example: if Pentacel (DTaP,IPV, HIB) is selected, and a user then selects DTaP, this will prompt the alert display because DTaP is a component in both vaccines. Depleted Inventory/Set-up Required Alert If a selected vaccine has an inventory that has been depleted (no vaccine in stock) or the vaccine has not been set up in Ngkbm Immunizations, then an alert will display to prompt the user to contact the site Immunization Coordinator or NextGen System Administrator. In this example, the inventory for Influen za has been depleted. 13

24 Allergy Confirmation Alert If a patient is allergic to a substance that may or may not be contained within a vaccine, a confirmation alert will display. This type of an alert is considered a soft stop as opposed the hard stops mentioned above. The difference between soft stop vs. hard stop alerts is soft stop will still allow you to proceed by selecting Yes when prompted. Selecting No will effectively cancel the ordering process. The example below is the confirmation alert display that presents when a user attempts to order MMR vaccine with an existing Egg allergy. Pregnancy Confirmation Alert Another confirmation alert (soft stop) that may display is a pregnancy confirmation alert. This will display when a selected vaccine that may be contraindicated in pregnancy is selected, and the Button is selected. The example below is when MMR is attempting to be ordered by a user for a pregnant patient. 14

25 CAIR Consent SVCHC uplinks all information into CAIR unless the patient (or the patient s parent or legal guardian) opts out. CAIR consent must be updated one time per year. CAIR Consent Alert on the Immunizations Pediatric template In order to notify staff members that a patient has or has not given CAIR consent, an alert has been added to the top of the Immunizations Pediatric template. This alert in RED TEXT will display if documentation regarding a patient s consent for the CAIR Registry has not been documented in the NextGen EHR. (see screenshot below) CAIR Consent Alert on the Immunizations Adult template 15

26 Like the Immunizations Pediatric template,, an alert has also been added to the top of the Immunizations Adult template. This alert in RED TEXT will display if documentation regarding a patient s consent for the CAIR Registry has not been documented in the NextGen EHR. (see screenshot below) Completing the CAIR Consent pop-up template In order to document a patient s level of consent as it pertains to the CAIR Registry, a pop-up has been created. This pop-up can be accessed two different ways on the Immunizations Pediatric and the Immunizations Adult templates in NextGen: 1. Select the alert text display (red text or exclamation icon) 2. Select the CAIR consent active text link Commented [JV1]: Cheryl, Consent must be done prior to immunization being ordered or given. This really needs to be stressed to Back Office. It is the way the interface requires it; this is a hard code that NextGen placed. On the CAIR Consent pop-up template, there will be three radio button options to select from. Once of these options is required in order to indicate that CAIR Consent has been completed. These options are: Yes, the patient gave consent No, the patient declined consent Unknown, the patient did not answer Screenshot of the CAIR Consent pop-up template 16

27 Once an option has been selected, the Date will default with the date of service date (encounter date). If the date of consent is not the encounter date, it can be changed by selecting the field, and then selecting a date from the calendar display Once an option has been selected on the CAIR Consent pop-up template, and a date of consent identified, the RED TEXT alert on the Immunizations Pediatric and Immunizations Adult template will hide from view. However, the CAIR Consent pop-up can still be accessed by selecting the CAIR consent active text link 17

28 Generating a CAIR Consent document Once a level of consent and consent date has been identified on the CAIR Consent pop-up template, a CAIR Consent document can be generated. This is completed by selecting the the CAIR Consent pop-up template. button on 18

29 Screenshot of the CAIR Consent document If a level of consent has not been specified, or if a date of consent has not been specified, an alert message will display if the button is selected. 19

30 The CAIR Consent document will automatically save to the patient s encounter. This will display in the History Toolbar under the date of service in which it was generated. Once you have obtained consent place complete your immunization order as normal. Make sure you have the Registry set to CAIR and click on the Save & Send button to send it to CAIR. 20

31 Vaccine Orders Module Once vaccines are ordered, they are processed in the vaccine orders module, which is located within the second collapsible panel on both the Immunizations Pediatric and Immunizations Adult templates. Processing Vaccine Orders Once vaccines orders have been placed, the MA or Nurse needs to process these orders in the Vaccine Orders Module. This includes printing Vaccine Information Sheets (VIS), selecting a lot number from the inventory, and documenting the site of administration. To access a vaccine order for processing, locate the vaccine within the Vaccines Orders Module (should be in a Pending status) and double-click the item. 21

32 Double click to access Polio Order Note: when a vaccine with multiple components is ordered, they will display in the Vaccine Orders Module brokendown by each component item. For example, Kinrix will display by each component as DTap and Polio. Once you double click the vaccine order to be processed, the Print VIS screen will display. This is where the user will print the Vaccine Information Sheets that are required to be distributed to patients or parents/caregivers of patients. Select Print to print VIS documents 22

33 After printing VIS documents, the vaccine order processing screen will appear. This is where the MA or Nurse performs the actual documentation of the administered vaccine. The first step in this process is to address the information at the top of the screen by selecting: 1. A Registry (should default to CAIR), 2. VFC if the patient is receiving state funded vaccines including VFA (Fund 317), 3. A VFC reason from the drop down. This section must be completed even if the patient will receive vaccines from our private inventory, and 4. The funding source. See the grid below for further information. VFC Eligible: Reason: Box 1 below Box 2 below Medical / Medical Managed Care Yes (Box is checked) VFC eligible American Indian / Alaskan native VFC eligible Uninsured VFC eligible Underinsured Funding Source: Box 3 below State State State State State Notes: This would be for patients on Medi- Cal, Partnership Health Plan, etc. Look at patient toolbar to check insurance type. Select if patient is a minor and the visit is being paid by straight CHDP or if the patient is an adult and the insurance type is uninsured. This means that the patient has an insurance coverage that will not pay for vaccines. No (Box is unchecked) Not VFC Eligible Private Funds Patient has private insurance. 23

34 1 2 3 Note: If the vaccine being administered is from VFC stock, and VFC is not selected at the top of the screen, then the lot number will not display The first next in this process is to select the vaccine from the grid at the top of the screen, then select the appropriate lot number from the Lot# field, and documenting the site of administration. Depending on how complete the vaccine was set up in Ngkbm Immunizations (see pages 3-8), most fields will autopopulate with information to include dose, route, billing CPT code, number of components, and expiration date. If these fields to not auto-populate, then they will need to be documented as well. In the example below, notice that when lot number U5607AA is selected, the Manufacturer, Brand name, Expiration date, Units, route, and NDC ID all auto-populate from information that was already setup in Ngkbm Immunizations. Note: If the vaccine being administered is from VFC stock, and VFC is not selected at the top of the screen, then the lot number will not display when the Lot # field is selected. Once all fields for the vaccine order has been completed, and all vaccine orders have been processed, select Save & Send at the bottom of the template. This will upload the vaccines into the CAIR registry. 24